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Impact of Severe Extracranial ICA Stenosis on MRI Perfusion and Diffusion Parameters in Acute Ischemic Stroke

Philipp Kaesemann1, Götz Thomalla2, Bastian Cheng2

  • 1Department of Computational Neuroscience, University Medical Center Hamburg-Eppendorf , Hamburg , Germany.

Frontiers in Neurology
|December 25, 2014
PubMed
Abstract

Insights

A coexisting internal carotid artery (ICA) stenosis has minimal impact on acute ischemic stroke lesion volumes and diffusion parameters. However, it may lead to moderately elevated cerebral blood volume (CBV) in middle cerebral artery (MCA) occlusion patients.

Area of Science:

  • Neurology
  • Radiology
  • Cardiovascular Science

Background:

  • Acute ischemic stroke due to middle cerebral artery (MCA) occlusion is a leading cause of disability.
  • Internal carotid artery (ICA) stenosis can coexist with MCA occlusion, potentially affecting stroke pathophysiology.
  • Understanding the impact of combined pathologies is crucial for effective treatment strategies.

Purpose of the Study:

  • To investigate the effect of concurrent ICA stenosis on lesion volumes in acute MCA occlusion stroke.
  • To analyze the influence of ICA stenosis on diffusion and perfusion parameters in MCA occlusion stroke.
  • To determine if ICA stenosis alters tissue-at-risk (TAR) volumes in acute ischemic stroke.

Main Methods:

  • Retrospective analysis of MRI data from 32 acute ischemic stroke patients with MCA occlusion (within 4.5 hours of onset).
  • Patients were divided into two groups: MCA occlusion alone (n=16) and MCA occlusion with concomitant ICA stenosis (n=16).
  • Semi-automated segmentation of diffusion lesions (ADC) and calculation of perfusion parameters (CBV, CBF, MTT, Tmax) were performed. TAR volumes were derived from hypoperfusion lesions (Tmax > 6s).

Main Results:

  • No significant differences were observed in diffusion lesion volumes or TAR volumes between the groups.
  • Cerebral blood volume (CBV) was the only parameter showing a significant difference (p=0.009), with higher values in patients with ICA stenosis.
  • No significant differences were found for other diffusion (ADC) and perfusion parameters (CBF, MTT, Tmax).

Conclusions:

  • Coexisting ICA stenosis has a limited impact on lesion volumes and most perfusion parameters in acute MCA occlusion stroke.
  • A moderate elevation in CBV in patients with ICA stenosis may indicate improved collateral circulation or ischemic preconditioning.
  • These findings suggest that while ICA stenosis doesn't drastically alter stroke core or penumbra size, it may influence hemodynamic compensation mechanisms.
Keywords:
brain ischemiadiffusioninternal carotid artery stenosismagnetic resonance imagingperfusion

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